When valid prescriptions are refused

How patients can file complaints

Drug Topics contributor Steve Ariens is a nonstop crusader for the rights of pharmacists. A cause about which he is equally passionate is the suffering inflicted upon chronic pain patients denied access to the medications upon which they depend and for which they hold legitimate prescriptions. He has warned in the pages of Drug Topics about possible consequences for pharmacists who refuse to fill valid Rxs. Now he offers a page of simple instructions for patients on how to file complaints.

Steve AriensIf a patient is denied a medication upon presentation of a valid/on-time prescription for a controlled substance, that patient may be eligible to file an ADA complaint.

If the patient is disabled, as determined by coverage under Social Security, Medicare, or private disability insurance, that patient is covered under the Americans with Disabilities Act (ADA). Many chronic pain patients meet this criterion.

The ADA parallels the Civil Rights Act of 1964. People who are disabled cannot be discriminated against because of their disabilities.

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First off, this is a very informative article. I am in a situation where I know someone who has been refused filling his prescription for what I believe is personal reasons. This person is funded by the disability resource center at his university. He suffers from severe ADD, dyslexia, and many other mental disabilities. I am not sure if he is considered disabled under the American government, however, he is able to fill his perspiration at only two locations. He has filled his prescription at the one location for over a year. In that time, the company has consistently delayed his perceptions for multiple reasons. Recently someone dropped his prescription off (valid/on-time) and an hour later a pharmacist tech called him saying they were out of his prescription. When he asked if they were out of it all together, she said they were out of it for him. She then handed the phone to her manager, who said they were not filling filling his prescriptions any more, but refused to give a reason for refusing to fill his prescription. His only reason was "we want tot make sure all our customers get the best service they can, so we will not be serving you any more..." that was the only reason. the patient being denied had recently announced to one of the techs that he was given the wrong prescription. he looked up the pill he received and the name on the bottle and realized the bottle was mislabeled. from what he understands, the pharmacist simply did not want to deal with him. he quoted "i do not want to cause any problems..".
I want to know if he violated any laws. this seems like severe discrimination to me. He refused to give a valid reason and denied him as a patient because they did not want to hear him comment on flaws in their system. I am personally disgusted that someone would deny a disabled person of drugs due to frustration with that patient (because he was pointing out that his company had drastically violated DEA regulations...) The manager hung up on this patient during the call where he refused him. He told the patient to come back and pick up the prescription. Again, after consistent questioning for reasoning as to why he was refusing him, his only reasoning seemed to be that he didn't want to cause problems and wanted this patient to get the best service.
I believe this pharmacist violated his rights. He can only receive his prescription from two companies. One is CVS, who is always "out of stock"... we live in a college town. Everyone is prescribed adrenal of sorts. And we have a person who is funded by the disability resource center at the university and he is being denied medication because he annoyed the pharmacy by informing them they had mislabeled his prescription. I feel that this is a severe violation of rights. This man can only be prescribed by two companies. One is always "out of stock". and the other is refusing to accept his valid on time prescription because they do not want to "deal with his complaints" anymore.
I need to know what complaints this patient can file. This is beyond inappropriate. To have a pharmacy manager hang op on a customer dying him medication and not saying why, should not be allowed. BTW, there is proof of all the mislabeling on drugs. photos were taken of the pills, the bottle and thee legitimate medical description. please inform me of all rights the patients holds, (in any context, disabled, not, whatever). Any situation....
Thank you.

Maybe you pharmacists who are all so upset should do something else. Stabbing one of his own? He's not an angry disgruntled pharmacist bitching about reimbursement, workloads, and if he's so wrong why are there so many pain patient's talking about how they get treated like junkies? It's because they do. I didn't need 27 years of experience, it took 3 years of listening to the way the 15 pharmacists I've worked with talk about patient's on pain medications. You guy's pretending to be doctors and judging people make everyone look bad. Then you come on here like little babies complaining because he's not the angry pharmacist talking about how stupid all your customers are. Retail as really warped your minds, like C.O.s and police officers, maybe you guys should talk to someone. Turning away someone because they seem fishy doesn't count as a point for your "judging abilities" because all you did was turn them away without any confirmation if you were right. Sorry Doctor's talk down to you, maybe you should stop questioning their judgement and diagnosing patie...CUSTOMERS. Sorry you all have little man's syndrome because no one realize's how much you know and everyone treats you like pill counting monkeys.

Big talk from Mr Anonymous. "3 years of listening to the way 15 pharmacists talk?" Where do you work that actually has 15 pharmacists? This article and your ignorance is why pharmacists have come on and shown their outrage through these comments. Do you understand that majority of the problem is the DEA and how they have prosecuted not only pharmacists but fined companies millions of dollars for dispensing "too much narcotics". Look it up before you come on here and speak as if you know something. Look into the pharmacies in Florida. Look into the countless number of doctors that have been arrested. Maybe read into the laws and how the DEA is pretty much taking away the dea licenses of pharmacys across the country, and THEN make your comment.

The problem does not stem from our Drug Enforcement Administration, Mr. Rahimi. It stems from pharmacists being too liberal with the dispensing of narcotic drugs spanning the last few decades, which has created a type of nationwide pandemic. It's very simple you see.. that is if you remove the rose glasses.
It's important to note the Drug Enforcement Administration is partly to blame for not enforcing the laws sooner, which has contributed to pharmacists being allowed to conduct themselves as if they were physicians and in some cases psychics. However, now that they have finally dropped the hammer, the majority of pill counters are terrified of losing their licenses or facing prison for dispensing lawfully prescribed pain medications. I assign the phrase pill counters to many pharmacists because in the very near future most pharmacists will be replaced with automation- as it should be. Also, there are now systems in place to verify if patients have a history of abuse.
On a side note, your post was rather juvenile in nature. Allow me to turn the table momentarily by saying I sincerely hope you contract a very painful yet invisible and incurable disease sometime in the near future so you can experience the joy of being treated like a drug seeking pharmacist.
Wishing you all the best!
P.S. Do you know who else counts things for a living? Many of America's lowest paid positions such as fast food workers, warehouse personnel and migrant farmers. The point? Like them, you are quickly becoming obsolete. Welcome to the age of technology.

I'm an RN AND a chronic pain patient. I have also worked as a triage nurse, and I can tell you that 90% of the people with horrendous physical problems look OK. You really can't size people up by looking at them, just like you can't size up child abusers and spouse abusers by looking at them. Certain pharmacists have treated me horribly, apparently because I do not look sick enough, or because I seem too "spaced out" to them. They don't bother to ask me any questions; if they did, they would find out I'm not "spaced out;" instead, I'm exhausted from working 10 1/2 hour shifts and that my pain meds make me tired, not "high."
But you can't win with the pharmacists. They are always looking for some tiny shred of evidence to support their prejudices against narcotic pain medication.
I have scarring on my sacral nerve that causes intense burning pain in my genitals 24 hours, 7 days a week. I was ready to commit suicide before I was referred to my pain doctor. I am thankful everyday for my pain medication. I have tried acupuncture, physical therapy, meditation, Tai Chi, QiGong,meds for neuropathic pain such as Elavil, gabapentin, lyrica, topamax, etc. (due to liver enzymes I am a slow metabolizer and most meds for neuropathic pain do not work for me and instead make me ill) and am getting ready to try massage therapy. Everything helps a little, but only narcotics make my life liveable.
Opana does not make me high, it just makes me tired. No pharmacist has the right to decide it shouldn't be dispensed to me. My pain doctor has spent FOUR YEARS trying different modalities to relieve my pain, and some pharmacist can just come along and say "Nope!" to a prescription? That's ridiculous!

wow... I was going to jump in with my usual brilliant insight but it seems like all the right points have already been made. Sorry, Steve. I like reading your blog and your articles but I find it increasingly difficult to agree with your viewpoint on this subject. We are not here to not fill prescriptions. Pharmacists know what to do and we can tell the good ones from the bad ones.

Do you for 1 second believe pharmacist do not want to fill a prescription for someone in need. Sure there are a very small amount of mistakes made when a so-called legit Rx for a person in true pain is not filled. But in all cases the person should have taken responsiblity on where and how they get the rx filled. Maybe just Maybe even the MD who is writing the Sch 2(we all know these are rxs you are talking about) should take some responsibility in educating the patient. None of us went to school or want to be the police but it seems noone else is doing the job! As a now partime pharmacist who has work at alot of stores the problem is all the so-called legit rxs that are being filled.

I was taught since pharmacy school that I have a "right to refuse" to fill any prescription for any reason I deem necessary. I refuse to fill any prescriptions for someone that is verbally abusive to me or my staff. I refuse to fill any oxycodone prescription that the customer asks for the M's or the A's. I refuse to fill any prescription that reimburses well below cost. I feel my right to refuse is just as important and necessary as any other civil rights we have.

I do not for a minute believe you have the right to deny patients medications; you have not earned an MD (were you refused admission to medical school and are taking it out on innocent patients), and your knowledge of the patient is limited. You cannot tell by looking at someone whether they need medication for their prostate, can you???? Can you diagnose spinal cord injuries and prescribe appropriate medication? You do not have the training nor the diagnostic information necessary to make these decisions. And if you have not experienced chronic pain, you have no idea how it can impact a person's life. KNOCK IT OFF. STOP PLAYING DOCTOR OR GOD.

I do not for a minute believe you have the right to deny patients medications; you have not earned an MD (were you refused admission to medical school and are taking it out on innocent patients), and your knowledge of the patient is limited. You cannot tell by looking at someone whether they need medication for their prostate, can you???? Can you diagnose spinal cord injuries and prescribe appropriate medication? You do not have the training nor the diagnostic information necessary to make these decisions. And if you have not experienced chronic pain, you have no idea how it can impact a person's life. KNOCK IT OFF. STOP PLAYING DOCTOR OR GOD.

I do not for a minute believe you have the right to deny patients medications; you have not earned an MD (were you refused admission to medical school and are taking it out on innocent patients), and your knowledge of the patient is limited. You cannot tell by looking at someone whether they need medication for their prostate, can you???? Can you diagnose spinal cord injuries and prescribe appropriate medication? You do not have the training nor the diagnostic information necessary to make these decisions. And if you have not experienced chronic pain, you have no idea how it can impact a person's life. KNOCK IT OFF. STOP PLAYING DOCTOR OR GOD.

I do not for a minute believe you have the right to deny patients medications; you have not earned an MD (were you refused admission to medical school and are taking it out on innocent patients), and your knowledge of the patient is limited. You cannot tell by looking at someone whether they need medication for their prostate, can you???? Can you diagnose spinal cord injuries and prescribe appropriate medication? You do not have the training nor the diagnostic information necessary to make these decisions. And if you have not experienced chronic pain, you have no idea how it can impact a person's life. KNOCK IT OFF. STOP PLAYING DOCTOR OR GOD.

I do not for a minute believe you have the right to deny patients medications; you have not earned an MD (were you refused admission to medical school and are taking it out on innocent patients), and your knowledge of the patient is limited. You cannot tell by looking at someone whether they need medication for their prostate, can you???? Can you diagnose spinal cord injuries and prescribe appropriate medication? You do not have the training nor the diagnostic information necessary to make these decisions. And if you have not experienced chronic pain, you have no idea how it can impact a person's life. KNOCK IT OFF. STOP PLAYING DOCTOR OR GOD.

Steve, It is obvious you don't work behind a counter for a living. I trust my instincts and 27 years of experience. If you or any patient don't like my decision call anyone you wish....you whine about the patient with a "timely" prescription, but what about my corresponding liability? Sure Pharmacy as a profession and Pharmacists as practitioners have problems with PBMs, insurance companies, etc. but we also have problems from self proclaimed "expert" desk jockeys like you that want to dictate policy from a desk without ever having real world experience in solving real world problems.

As a pharmacist and the husband of a chronic pain medication patient, I see both sides. I have refused prescriptions that were questionable that I could not validate.
I can also say that my wife has often felt and been treated like a criminal by pharmacists when trying to fill her prescription for the first time at a new pharmacy. I wish this article would have addressed the real issues and solutions like, always use the same pharmacy. Make sure you fill your prescriptions at times that your physicians office is open for verification of prescribing. I think it is criminal what some physicians are required to provide to get a legitimate prescription filled for their patients at some pharmacies, it is one thing to follow up on a suspicious prescription, but something else to create global CYA policies that make filling legitimate prescriptions feel like a crime.

As a pharmacist and the husband of a chronic pain medication patient, I see both sides. I have refused prescriptions that were questionable that I could not validate.
I can also say that my wife has often felt and been treated like a criminal by pharmacists when trying to fill her prescription for the first time at a new pharmacy. I wish this article would have addressed the real issues and solutions like, always use the same pharmacy. Make sure you fill your prescriptions at times that your physicians office is open for verification of prescribing. I think it is criminal what some physicians are required to provide to get a legitimate prescription filled for their patients at some pharmacies, it is one thing to follow up on a suspicious prescription, but something else create global CYA policies that make filling legitimate prescriptions feel like a crime.

Yes to what everyone has said, this article is a joke and an embarrassment to all pharmacists. Seriously?!?! We get poor reimbursement from insurance, disrespect from MD's and their staff, abused by patients all day but none of this comes close to one of our own stabbing us in the back. Tell me, do your efforts to punish your own get you any extra points from your MD cohorts in your cushy consulting job? Couldn't get into medical school? What is your problem? What we need from so-called "thinkers" like you who have time to write articles like this is real solutions for everyone involved. Thanks for setting us back more than few steps...

pardon me but unless you own the pharmacy or make a commissiom on it what does it matter about cost to you, i was once a chronic pain patient, i never had a pharmacy flat out refuse me but they did refuse to fill it because of my doc, there was a doctor in the state over with the same name that was being looked at by the dea, the only thing different was the middle name and a different dea number, this caused him and his patients alot of headaches at the pharmacys because they wouldnt take the time to investigate the issue, i honestly think that chronic pain patients should have to wear a braclet like the allergy one that gets scanned at the pharmacy that tells them the diagnosis, what meds there on, and can tell them if they are getting them from more then 1 doctor, i wouldnt want to be the one that denied someone the pain meds they need because of cancer or dying from some other disease

Very troll like article designed to generate a response, which it did. Like most pharmacists , I make an honest effort to follow, and keep up with the law, as well as my employers strict guidelines. I trust my instincts and try to be compassionate.
I can't decide if the title PD means police department or per diem, but I doubt the authors experience involves any pharmacy work in a community setting. Perhaps it is a typo for JD.

I practice in Florida and the regulations have always allowed us to fill prescriptions for our out-of-state tourists. That said, when presented with a controlled prescription it was always incumbent upon us to verify the validity of said Rx. In today's Pharmacy practice and to completely be assured of the validity of the Rx we commonly contact the prescriber to verify and always note the date, time and name of the person authorizing. There are many times that we won't fill a particular prescription, not because we feel it isn't legitimate but perhaps the prescriber is unknown to us and/or the patient resides 40 or 50 miles away. We tell them to have the Rx filled where they are known. Another problem we have is that we check each prescription with the state data base and we know that the data is wrong. It hasn't been updated and we can't see what or when they had the item filled last.
A similar bone of contention I have is those Pharmacists who insert their religious beliefs into what they will or will not dispnse.
The distributors have been put under a lot of scrutiny these past years but without any specific guidelines they made these arbitrary quota allocations. When it comes to about the middle of the month we cannot get any more of the CII's. So how do I tell my long time patient/customer that has a prescription for a pain killer such as Oxycodone that they have to wait two weeks until I get my next supply.

A prescription must be issued for a legitimate medical purpose and in the usual course of professional practice, otherwise it is not valid according to Federal Law. When a prescriber gives someone oxycodone 30 mg without first trying a less potent agent or dose to see if that will relieve the pain, it is not the usual course of professional practice, and therefore not a valid prescription. Mr. Ariens, you obviously don't work in retail like most of us do. You probably have some cushy desk job somewhere and you actually get to sit down at work. Do you even dispense any prescriptions at all? Because were I work, if you fill 2 oxycodone 30 mg rx's today, you will have 100 of them tomorrow, and the next day the DEA will be knocking on your door. Having said that, all of you pharmacists who say "I don't have it" when you do have it are liars and are perpetuating the problem. You can be penalized by the Board of Pharmacy for lying to the patient like that, but you have the right to refuse the rx if you think it hasn't been written according to accepted medical standards, ADA or no ADA. Mr. Ariens, you are not even offering a solution, and I'm not sure what your purpose was in writing this article other than to annoy people. The DEA and unethical prescribers are the real cause of this problem. The DEA is so ambiguous and vague and will never tell you it's OK or not OK to fill an rx and they have no specific criteria to define a valid rx, or how many rx's are too many. Therefore, most pharmacists would rather err on the side of caution instead of getting a huge fine and losing their license. Furthermore, we retail pharmacists (except most independents) have lost most of our autonomy long ago. We report to non-pharmacist managers who don't care about us, and boards of pharmacy don't want to interfere. Our predecessors allowed this to happen because they didn't want the responsibility and work of running a store and just wanted to stay in the back and fill scripts. And we traded good working conditions for higher pay (now the pay is going down and the conditions are getting worse). And then the insurance companies. Now our profession is going down the drain. We need to stand together and speak out against the injustices being done to us. Write to your congressmen, complain to your state board or your supervisor or whoever will listen because it's getting worse every year and soon we'll all be replaced by robots if we do nothing.

HIPAA? Are you kidding me? That's like saying "The man who assaulted me jaywalked across the street to beat me to a bloody pulp! Give him a citation for the way he crossed the street!" If you want changes made to the way pharmacists are dealing with drug addicts and quack physicians, stick to the actual issue.

So who decides what is a legitimate prescription? My rule #1 is that I do not live in someone else's body so I do not judge nor is it my job to confirm diagnoses. Having said that I see so many questionable prescriptions for high dose narcotics from patients that look like models from yoga commercials or under 40's that move much easier than my 5 decade body ever will again. I live in an area that receives many visitors but prescriptions for 240 Roxicodone 30mg from anybody other than a local patient or physician will rarely get filled by me. I have been "threatened/warned" by my employer, state regulatory agency and the DEA about filling narcotic prescriptions so adding the ADA lawyers is no big deal. If I go to trial you can be damn sure the prescriber better have his records available for scrutiny as when I ask an agent of the state or DEA if a physician has been contacted or interviewed the answer is always "no".

I commend the author Mr. Ariens for his thoughtful load of B.S. He does not work in Realville. He may be fine at developing software or working in a 6 physician office as a pharm D consultant on pain management (yes his resume is online). I understand he is an advocate for the pain management crowd.
I believe in an aggressive stance on pain management; however, if I practiced in the way the author suggests I would have every doper in town on my front step. If I took mr. Arien's recommendations, I would blindly fill the doper combo of Xanax 2mg, Soma 350mg, Oxy 30, and Norco 10 for the 20-somethings that walk in off the street with "back pain" or "chronic pain" but there is no Lyrica, gabapentin, etc. By Mr. Ariens logic, I should fill this no questions asked as long as it's on time. There are bad doctors in this world (I've helped lock up several) and plenty of bad "patients". By Mr. Ariens logic, I should sell a box of 24 hour Sudafed to the 4 people in line in a row that came in together. Pharmacists do have a reasonable responsibility to prevent drug diversion. It is bad that some people get caught in the crossfire but how dare you, Mr. Ariens, try to nail your "supposed fellow pharmacist" for trying to do the right thing. Do you know Mr. Ariens that a script for 120 oxycodone 30mg is worth about $4000 on the street? Do you know, Mr. Ariens how many deaths come from diverted medications? Did you know Mr. Ariens that there was a doctor in Oklahoma city that was sentenced last year to prison that killed over 93 patients? His people filled their scripts on time. I would think after working in the business for so many years you would not be as naive as you seem to be. ADA...really? Maybe in some cases, but not the majority where I am at. This is not a black and white issue. Come to Reallville and work in the trenches, Mr. Ariens. The dopers will love you.

Anonymous, here in Florida we use a super-duper magic marker to identify patients who are truely in pain. It turns red if they are. Joking a side, I concur. Thanks to our DEA, there is not enough to go around. Each and every wholesaler limits CII's, benzo's and hydrocodone. That is the wholesalers that still deal with Florida. So the Federal government, who has their jack-booted foot on the wholesalers, can go after me with this author's help? Some of us compound ocycodone and hydromorphone while working in concert with the physicians and the DEA is in the process of snuffing that out. In Florida, we are on our way to legalizing pot and criminalizing FDA aoroved medications. Thank you government.

Does the pharmacist have the right to refuse a legitimate prescription when the PBM pays $25.00 less than cost or can he just say we are "out" of this drug? The PBM is denying the drug not me as my independent store cannot and will not fill prescriptions like this. There needs to be a national law that PBM's must update prices daily or at least weekly and that if a pharmacy shows they paid a higher price it must be honored. I filled a RX, after hours for 90 furosemide 40 MG, a 90 day supply and my total reimbursement was $1.04. Now in all fairness would a PBM fill and mail a Rx to a member for $1.04 for a 90 d/s. I have come to realize that there are some Rx's I just cannot fill so I send them to my competitors the chains. They fill them no questions asked and this my friends is why pharmacy finds itself in the position it is in today. Our patients may love us and respect us but the insurance industry and the PBM's have no respect for us at all, and they shouldn't. We are our own worst enemy and it gets worse every year. My years are winding down but I feel very sad for the younger pharmacists that have spent 6 years of their lives, are well trained and face these challenges.